The technique for radical cystectomy in women is described, with special consideration given to the pelvic anatomy, and the urethra- and nerve-sparing approach in female patients. Advances in understanding female pelvic anatomy, following detailed animal, cadaveric and clinical studies, merged to give a better intraoperative identification of the sphincteric apparatus and neurovascular structures. Respecting the oncological premises, cystectomy in female patients can be done with a nerve-sparing technique. In rare cases the entire inner genitalia, including the anterior vaginal wall, can be preserved, which might lead to improved functional results with greater patient satisfaction. However, the oncological result should never be endangered by organ preservation.